Experts
say SARS underlines need for global biodefense

The
United States can best protect itself against global
epidemics by bolstering the defense capabilities of
its allies, university experts said last week.

"The
lesson from SARS, when it come to biodefenses, is not
so much what we need to do within the U.S. but what
we need to do internationally," said Michael
Lynn, a visiting fellow at the Center for
International Security and Cooperation (CISAC).
"The better able countries are in dealing with
their own epidemics, the better off we are. SARS is a
gentle reminder that our fate is intertwined with
that of other nations."

Lynn, a
physician, discussed the worldwide SARS (Severe Acute
Respiratory Syndrome) epidemic at a panel sponsored
by the Institute for International Studies on June 4.
At the time, 8,300 cases of the contagious virus had
been reported, 5,350 of which were in the People's
Republic of China, where it first appeared last fall.
John Lewis, professor emeritus of Chinese politics;
Douglas Owens, associate professor of medicine; and
Margaret Race, a biologist and visiting CISAC fellow,
also participated in the lunchtime discussion.

Although
the broader U.S. medical community has understood the
significance of SARS as a new kind of disease, Lynn
said he was skeptical of the level of understanding
among Washington policymakers.

"They've
been congratulating themselves we've done such a
fantastic job in this country ... [that] we've done
everything right," he said. "I would argue
that is exactly the wrong lesson to take from SARS. I
think we've been exceptionally lucky [that no one in
the United States has died from SARS] and that this
will come back to haunt us if we're not careful next
fall and winter. If SARS follows the traditional
appearance pattern of influenza, I suspect we will
see a lot more cases at that time."

According
to Owens, SARS could become a "very
difficult" problem during the upcoming flu
season because both illnesses share the same
symptoms. This spring in Santa Clara County, he said,
90 people were classified as "pre-suspect
SARS" because they shared a relevant travel
history to an area hit by the disease, and had a
temperature or a cough -- but not both. These people
were quarantined at home for 10 days. Nationally,
California has had the highest number of suspected
and probable cases of SARS -- 68 -- with 25 of those
in the Bay Area and 7 in Santa Clara County alone.
"We're in one of the places where SARS has shown
the most because it's an entry point for travel from
Asia," Owens said. "The health community is
quite tuned into this."

Despite
such expertise, diagnosis of SARS -- which is
untreatable -- remains difficult. "No one has
said a good diagnostic test will be developed by
winter," Owens said. "It's going to be a
major problem." Developing an effective vaccine
"could take years," he added.

Lewis, a
veteran China expert, cautioned that SARS could
proliferate in a manner similar to the deadly Spanish
influenza pandemic of 1918-19. Although Western
sources report that 22 million died from the disease,
Lewis said, Chinese figures state a far higher 70
million deaths because "huge numbers of deaths
in Asia didn't get reported."

China is
particularly sensitive to the global outbreak of
SARS, Lewis continued, because in the spring of 1917,
tens of thousands of Chinese workers were sent to the
Franco-German front to dig trenches during World War
I. According to Lewis, workers carried the flu virus,
which then spread to soldiers. After the Armistice
was signed in 1918, soldiers brought the disease home
with them and it quickly spread worldwide. Lewis said
this experience helps explain why Chinese
authorities, after initially failing to face the SARS
crisis, have launched a full-scale military response
to the epidemic.

In his
presentation, Lewis gave a chronological overview of
how SARS first appeared and proliferated in the
People's Republic of China. Although high numbers of
random deaths began to be reported in Guangdong
Province last December, officials decided not to
cancel New Year festivities in February. Millions of
people then traveled throughout China during the
weeklong holiday and helped to spread the so-called
"mystery disease." When the first two
deaths were reported in Beijing on March 19, the
city's mayor and the country's minister of health
decided to put suspected cases in 72 hospitals in the
capital. "They were like petri dishes that
spawned the disease all over the city," Lewis
said. "None of these hospitals were equipped for
a highly contagious viral disease."

With the
escalating number of reported SARS cases causing
worldwide outcry, Lewis said, the Chinese Politburo
met in "full battle crisis" April 19. In
the following days, officials canceled upcoming May
Day celebrations, fired the health minister and
Beijing's mayor, publicly reported sharply higher
numbers of SARS cases for the first time and
established a national headquarters for the
prevention and treatment of the disease. Under a new
nationwide command bolstered by high-tech
communication, officials organized the construction
of a 1,000-bed "battlefield hospital" north
of Beijing in just eight days. "It was a
national television event," Lewis said. "It
was the most dramatic mobilization of medical and
construction workers you can imagine."

When
Chinese Vice President Zeng Qinghong visited the
hospital a day before it opened April 30, he
described the battle against SARS in military terms.
"We are going to be like minesweepers on the
battlefield and clear the mines together," Lewis
quoted the vice president from his speech at the
hospital. "Yes, we're going to clear the
mines."

Since
April, China's firm response appears to have helped
stem the epidemic. For the first time in six months,
Lewis said, no new cases of SARS were reported June 3
and 4. On June 5, international health officials in
Beijing declared that the epidemic appeared to be
winding down.

Nevertheless,
Lynn said, SARS should be a "wake-up call"
to the potential threat posed by future epidemics.
"We want to keep diseases out of this
country," he said. "SARS has shown it's
great to be lucky ­ but we have to ensure our luck
the next time round." To do this, he said, the
United States should help pay for stockpiles of
medicines, antibiotics, vaccines and antidotes to be
set up in allied nations.

While
such stockpiles would be ineffective against SARS,
Lynn said they could be critical in combating other
deadly epidemics in an interconnected world.
"The fact remains that a smallpox outbreak
anywhere in the world, for example, in Paris, is
going to guarantee an outbreak in New York," he
said. "While the cost of providing biodefenses
is quite high, I think the cost of doing nothing will
be prohibitive."